The Case Manager coordinates resources and services in response to individual patient's needs and fiscal realities, performs utilization review activities and oversees coordination of complex discharge planning for assigned case load. The Case Manager is an active member of the interdisciplinary team contributing to team goal setting. The Case Manager acts as a consultant to the clinical team, service lines and other departments and participates in program development and quality improvement initiatives.
The Case Manager provides age-appropriate assessments, interpretation of data, and delivery of interventions. Demonstrates the ability to work with any patient regardless of race, gender, religious affiliation, cultural beliefs, lifestyle, disease process or treatment plan.
I. Reports To: Manager of Care Coordination, Director of Social Work and Case Management
II. Who Reports to this Position: the case manager oversees the work performed by the support liaison in relation to assigned cases, may supervise student interns
III. Frequent Contacts: Nursing unit staff, physicians, patients, patient families/significant others, insurance companies, DME providers, social workers, ancillary departments
1. Oversees and coordinates complex discharge planning needs for assigned patients in collaboration with other interdisciplinary team members, assuring a discharge plan is developed and implemented in a timely manner.
2. Collaborates with physicians, social workers, support liaisons and other interdisciplinary team members to assess, plan and coordinate patient care needs.
3. Educates patients/families and other healthcare providers regarding utilization management and discharge planning options.
4. Reviews prospectively, concurrently and retrospectively all in-patients for appropriateness of admission, level of care and determines appropriate length of stay.
5. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs.
6. Communicates with review organizations/payers requested clinical and psychosocial information to assure reimbursement.
7. Provides consultation and education to members of the healthcare team, hospital departments, service lines and community agencies and providers.
8. Participates in quality improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection. Participates on clinical process improvement teams within the department, services lines and hospital.
9. Participates in department program planning including goal setting, program development, systems development and improvement. Participates on department and hospital committees and task forces.
10. Demonstrates competency with work-required computer programs and incorporates use into daily work routine.
11. Demonstrates the ability to interpret data and trends using appropriate analytical skills.
12. Oversees and directs activities delegated and performed by the Support Liaison.
13. Considers age specific needs of the patient as appropriate and effectively
communicates and interacts w/ pts, families, staff and members of the community
from diverse backgrounds.
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
1. Possesses a Bachelor's Degree in a Healthcare related field; a minimum of three years of acute hospital clinical experience strongly preferred; or the equivalent of education and experience. Master's Degree in Nursing or Healthcare related field preferred.
2. Current California RN licensure required.
3. Recent experience in case management, utilization review or discharge planning preferred.
4. Knowledge and abilities essential to the successful performance of the duties assigned to the position.
5. Demonstrates resourcefulness, effective written and oral communication, diplomacy, organizational, and analytic skills.
6. Self-directed, assertive and creative in problem solving, systems planning and patient care management in a high volume work environment.
7. Basic computer skills.
8. Ability to work effectively and collaboratively with interdisciplinary teams.
Registered Nurse with current California license required.